Week 2 Flashcards
1
Q
What is gait?
A
The manner in which a person walks
2
Q
What is a step?
A
From the heel strike of one foot to the next heel strike of the contralateral (opposite) foot
3
Q
What is step length?
A
The distance between steps
4
Q
What is a stride?
A
From the heel strike of one foot to the next heel strike of the ipsilateral (same) heel strike. (lasts 1 sec)
5
Q
What is speed?
A
The rate of linear forward motion of the body
6
Q
What is cadence?
A
The number of steps taken per unit of time. Steps/min
7
Q
What is the general cadence for adult men
A
110 steps/min
8
Q
What is the general cadence for adult women
A
116 steps/min
9
Q
What is the general cadence for start of jogging/running
A
180 steps/min
10
Q
How do you increase gait speed?
A
By increasing stride length, & cadence
11
Q
What is a step width?
A
The linear distance between midpoint of heel of one foot and the same point on the other foot completing the step.
12
Q
What is the general step width?
A
Usually 3 and half inches, but can vary from 1-5 inches
13
Q
The step width is ____ in elderly and infants
A
Wider/larger
14
Q
What are the phases of the gait cycle?
A
Initial contact, loading response, mid-stance, terminal stance, pre-swing, initial swing, mid-swing, and terminal swing
15
Q
What percent is the stance phase of the total gait cycle?
A
62%
16
Q
What percent is the swing phase of the total gait cycle?
A
38-50%
17
Q
What is initial contact in the phases of gait?
A
The moment when the foot contacts the ground
18
Q
What is loading response in the phases of gait?
A
Weight rapidly transferred onto outstretched limb
19
Q
What is mid stance in the phases of gait?
A
Body progresses over a single, stable limb
20
Q
What is terminal stance in the phases of gait?
A
Body moves ahead of limb and weight is transferred to forefoot. Rapid unloading of limb occurs as weight is transferred to contralateral(opposite) limb
21
Q
What is pre-swing in the phases of gait?
A
Thigh begins to advance as foot comes off the floor
22
Q
What is initial swing in the phases of gait?
A
Thigh begins to advance as foot comes off the floor
23
Q
What is mid swing in the phases of gait?
A
Thigh continues to advance as the knee begins to extend
24
Q
What is terminal swing in the phases of gait?
A
Knee extends as the limb prepares for the contact with the ground.
25
What is happening in the other limb when the reference limb is going through initial contact and loading response?
Pre-swing
26
What is happening in the other limb when the reference limb is going through mid-stance?
Initial swing and 1st part of mid swing
27
What is happening in the other limb when the reference limb is going through terminal stance?
2nd part of mid swing and terminal swing
28
What is happening in the other limb when the reference limb is going through pre- swing?
Initial contact and loading response
29
What is happening in the other limb when the reference limb is going through initial swing and 1st part of mid-swing?
Mid-stance
30
What is happening in the other limb when the reference limb is going through 2nd part of mid-swing and terminal swing?
Terminal stance
31
Loading response(2nd phase) begins with ____ and ends with __
Begins with foot contact and ends with opposite limb toe off
32
Mid stance(3rd phase) begins with ___ and ends with ___
Begins with opposite limb toe off and ends with ipsilateral heel rise
33
Terminal stance(4th phase) begins with ___ and ends with ____
Begins with ipsilateral heel rise and ends with opposite limb foot contact
34
Pre swing starts(5th phase) with __ and ends with ___
Starts with opposite foot contact and ends with ipsilateral toe off
35
Initial swing (6th phase) starts with ___ and ends with ____
Starts with ipsilateral toe off and ends when the medial malleoli are aligned
36
Mid swing (7th phase) begins with ___ and ends with ____
Begins with the medial malleoli aligned and ends when the ipsilateral tibia is perpendicular to the ground
37
Terminal swing (8th phase) begins with ___ and ends with ___
Begins with the tibia perpendicular to the floor and ends when the ipsilateral foot strikes the floor
38
Where should the PT be positioned during gait training?
Behind the patient and to the side that is being treated. Place one hand with a supinated grip and the other hand in front of the shoulder
39
What assistive devices should be used with 3-point gait?
Crutches or walker
40
Assisted devices to use for a patient that has one leg affected and full weight bearing on the other leg is ___
Crutches or a front wheeled walker
41
For a patient with no weight bearing restrictions, ____ can be used
Bilateral canes
42
Where in the 5 elements of patient management does the subjective exam fall?
Examination and evaluation
43
What is the primary objective of the initial PT visit called?
Phase 1 differential diagnosis
44
What question is asked in the Phase 1 differential diagnosis?
Does this patient belong in my clinic?
45
Will the subjective exam ever need to come back in play?
Yes
46
What is the typical subjective exam flow?
1. Review Baseline Information/Chart Review
2. Establish Rapport
3. Gather General Information
4. Analyze Information/ Hypothesis Generation
5. Gather Specific Information
6. Plan Objective Exam
47
80% of info needed to make a diagnosis is contained in the ___
Subjective exam
48
What happens in the Review Baseline Information/Chart Review of the subjective exam flow?
• Provides needed information, like:
- General Health Status
- Imaging findings
- Operative reports
- Past medical history and/or treatments
- Medications
49
What part of the subjective flow may be the examination?
Review Baseline Information/Chart Review
50
What happens in the Establish Rapport of the subjective exam flow?
```
• Welcoming introductions
• Establish effective communication and
rapport
• Explanation of perspective
• Clarification of patient expectations
• Sequence of first session – exam process and patients role
```
51
What happens in the gather general information step of the subjective exam flow?
* Patient profile (age, gender...)
* Chief complaint
* Body chart
* Present Episode
* Past History
* Aggravating/Easing Factors
* Relationship between regions
* 24-hour behavior
* Patient Goals
* Patient Expectations
52
The ___ fills out the body chart
The patient
53
Problem area characteristics of of the body chart
* Location of each area of pain / symptoms
* Quality / Type of symptoms
* Depth of symptoms
* Frequency / Constancy of symptoms
* Relationships between areas of symptoms
* Clearing relevant areas
54
What are the two pain rating scales?
- Numerical Pain Rating Scale (NPRS): o a scale of 1-10
| - Visual Analog Scale (VAS) for pain
55
Which pain rating scale is used the most?
The NPRS
56
What are radicular symptoms?
direct stimulation of a nerve root results
| in a sharp, lancinating pain, well-localized to the dermatome.
57
What is a visceral referral symptom?
kidney, pancreas, cardiac, etc. - can mimic or masquerade as musculoskeletal pain.
58
What is a somatic referral symptom?
```
symptoms that arise from referral of a
musculoskeletal structure (i.e. facet jt.)
```
59
What is a trigger point symptom?
hypersensitive spot typically in skeletal muscle that can be associated with a taut band
60
What happens in the gather specific information step of the subjective exam flow?
* Date of onset
* Mode of onset (injury, any precipitating factors?)
* Gradual onset
* Sudden onset
* Immediate or delayed symptoms after injury?
* Pain and Swelling
* Are symptoms getting better, worse, or status quo?
* Any treatment to date? Effects?
* 24-hour behavior
61
What are the two factors of the behavior of symptoms that are very important?
- Aggravating and easing factors
62
What is a systems review?
Where we are asking questions that relate to the different systems of a given patient
63
What does a systems review do?
It helps us identify red flags
64
What are red flags?
Signs and/or symptoms that may warrant immediate communication with the referring provider or may warrant a referral/consultation to another healthcare
practitioner
65
The present of a single red flag is usually ____ and must be ___
Not much of a concern, and must be put into context with the rest of the patient's presentation(age, gender, med history...)
66
What is a category 1 red flag?
Factors that require immediate medical attention
67
What is a category 2 red flag?
Factors that require subjective questioning and precautionary examination and treatment procedures
68
What is a category 3 red flag?
Factors that require further physical testing and differential analysis
69
What is a yellow flag?
Factors that increase the risk of developing, or perpetuating long-term disability and work loss
70
A yellow flag may warrant ___
May warrant a referral/consultation to a mental health practitioner
71
Examples of a yellow flag
Psychosocial issues:
* Fear avoidant behavior
* Pain catastrophizing
* Loss of pleasure in doing things, feeling hopeless
* High levels of anxiety
* Suicidal ideation
72
What do we do to further refine our hypothesis of a patient?
Establish SINSS
73
What does SINSS stand for?
```
Severity
Irritability
Nature
Stage
Stability
```
74
What is severity?
The intensity of the patients symptoms as they relate to a functional activity
75
How is severity rated?
• Minimal = Minimal to no pain (0-3/10), symptoms do not limit or hinder activity
• Moderate = Pain reduces activity levels to 40-70% of normal, pain
rated at 4-7/10
• High = Pain symptoms severely reduce or stop activities; ADLs are
are avoided or severely limited, pain rated at 8-10/10
76
What is irritability?
Time for symptoms to come on and go away
77
How is irritability rated?
* Low = Tolerates repetitive or sustained activities, can cont. activity after the onset of pain, pain eases in short amount of time
* Moderate = Tolerates brief activities or positions < 10 min, cont. light activities after the onset of pain, pain eases in similar time as onset (may be longer)
* High = Activity not tolerated – are avoided, unable to continue activity after the onset of pain, symptoms takes a long time to ease (>30 minutes)
78
What are the two types of nature of a pain?
• Musculoskeletal vs. Non-Musculoskeletal
79
The type of pain often relays information to the clinician regarding the _____
type of tissue involved
80
The nature of pain is a reflection of ____
differential diagnosis and systems review
81
What is the stage?
Time frame since the onset of symptoms
82
What are the stages of pain?
* Acute pain: Recent onset (0-6 weeks)
* Sub-acute pain: Pain may be due to later stages of tissue healing or early stages of developing chronic symptoms (6-12 weeks).
• Chronic pain: Longer duration – usually past expected recovery time
(> 3 months)
83
What is stability?
The progression of the patients pain (or symptoms) over time
84
What are the ways to classify the stability of a patient's pain?
Is the patients pain:
• Getting better
• Staying the same
• Getting worse
85
If a patient has a high severity & irritability we may ____
Limit the SINSS, so as to not make them worse
86
If a patient has a low irritability we may ____
Not limit the exam, so as to reproduce the symptoms
87
Other things SINSS helps us understand
- Contraindications to the examination?
- Vigor of exam?
- Which structures will I examine?
- Will I do a neurological exam?
- Which examination techniques will I perform?
88
What are the reasons to screen a patient?
• Sicker patient/client base: more comorbidities
• Quicker: earlier mobility/discharge of hospital pts same day
surgery
• Disease progression
• Patient/client disclosure
• Presence of one or more yellow (caution) or red (warning) flags
• Direct Access: people coming off the street
89
What is direct access?
The right of the public to obtain examination, evaluation and intervention from a licensed PT w/out previous examination by or referral from a physician, gatekeeper or other practitioner
90
What is primary care?
“…integrated, accessible healthcare by clinicians
who are accountable for addressing a large
majority of personal health care needs,
developing sustained partnerships with
patients…”
91
What is a diagnosis?
Recognition of disease/disorder usually via a collection of relevant signs and symptoms
92
What is a differential diagnosis?
Systematic method to identify the cause
| (MSK or non-MSK) of a patient’s symptoms
93
What is a prognosis?
Predicted optimal level of improvement in function taking in consideration of comorbidities, motivation, psychosocial
factors, patient values/goals
94
What are constitutional signs?
are general signs/symptoms that are present when illness is present
95
What are the means of communication?
- Verbal
- Non-verbal
- Written
96
Verbal cues convey ___ of the message
7%
97
Vocal cues are __ of communication
38%
98
Facial cues are __of communication
55%
99
What is effective communication?
Message sent = message received.
New information makes sense to a person by
comparing it to what is already in their minds
100
Sources of communication error
* Language
* Psychological (listener)
* Environmental
* Speech (speaker)
101
Questioning techniques
• Speak slowly
• Speak deliberately
• Keep questions short
• Ask one question at a time
• Begin with open-ended and non-leading questions
• PAUSE – wait for and LISTEN TO response
• Confirm understanding with restatement or
paraphrasing strategies
102
What are open ended questions?
Questions that allows the patient elaborate on their answers
103
Definition of encoding barriers?
The process of selecting and organizing symbols to represent a message requires skill and knowledge.
104
What are the obstacles that can interfere with an effective message?
- Lack of Sensitivity to Receiver
- Lack of Basic Communication Skills
- Insufficient Knowledge of the Subject.
- Information Overload
- . Emotional Interference
105
Transmitting barriers are...
Things that get in the way of message transmission are sometimes called
“noise.”
106
Types transmitting barriers
- Physical Distractions
- Conflicting Messages
- Channel Barriers
- Long Communication Chain
107
Decoding Barriers. The communication cycle may break down at the receiving end for some of these
reasons:
- Lack of Interest
- Lack of Knowledge
- Lack of Communication Skills
- Emotional Distractions
- Physical Distractions
108
Responding Barriers—The communication cycle may be broken if feedback is unsuccessful:
- No Provision for Feedback
| - Inadequate Feedback
109
What are the 4 categories of non-verbal communication?
Physical
Aesthetic
Signs
Symbolic
110
What is physical non- verbal communication?
This is the personal type of communication. It includes facial expressions, tone of voice, sense of touch, sense of smell, and body motions.
111
What is aesthetic non- verbal communication?
This is the type of communication that takes place through creative expressions: playing instrumental music, dancing, painting and sculpturing
112
What is signs non- verbal communication?
This is the mechanical type of communication, which includes the use of signal flags, the
21-gun salute, horns, and sirens.
113
What is symbolic non- verbal communication?
This is the type of communication that makes use of religious, status, or ego-building symbols.
114
What are the static features of non- verbal communication?
Distance
Orientation
Posture
Physical contact
115
Static feature: Distance is characterized by...
The distance one stands from another frequently conveys a non-verbal message. In
some cultures it is a sign of attraction, while in others it may reflect status or the intensity of the exchange.
116
Static feature: orientation is characterized by...
People may present themselves in various ways: face-to-face, side-to-side, or even back-to-back. For example, cooperating people are likely to sit side-by-side while competitors
frequently face one another
117
Static feature: posture is characterized by...
Are we slouched or erect? Are our legs crossed or our arms
folded ? Such postures convey a degree of formality and the degree of relaxation in the
communication exchange.
118
Static feature: physical contact is characterized by...
Shaking hands, touching, holding, embracing, pushing, or patting on the back
all convey messages. They reflect an element of intimacy or a feeling of (or lack of) attraction.
119
What are the dynamic features of non- verbal communication?
- Facial expressions
- Gestures
- Looking
120
Dynamic feature: facial expressions is characterized by...
A smile, frown, raised eyebrow, yawn, and sneer all convey information. Facial expressions continually change during interaction and are monitored constantly by the recipient. There is evidence that the meaning of these expressions may be similar across cultures.
121
Dynamic feature: gestures is characterized by...
One of the most frequently observed, but least understood, cues is a hand movement. Most people use hand movements regularly when talking. While some gestures (e.g., a clenched
fist) have universal meanings, most of the others are individually learned and idiosyncratic.
122
Dynamic feature: looking is characterized by...
A major feature of social communication is eye contact. It can convey emotion, signal
when to talk or finish, or aversion. The frequency of contact may suggest either interest or boredom.
123
Definition of non-verbal communication according to Tortoriello, Blott, and DeWine
". . . the exchange of messages primarily through non-linguistic means, including: kinesics (body language), facial expressions and eye contact, tactile communication, space and territory, environment, paralanguage (vocal but non-linguistic cues), and the use of silence and time."
124
Empathic communication is described by Coulehan et al as...
language that aides the process of healing by bolstering patient’s strengths, validating their perspective, and teaching them how to grow to be more self-reliant
125
What are the habits in the 4- habit model?
- Invest in the beginning
- Elicit the patient's perspective
- Demonstrate empathy
- Invest in the end
126
Characteristics of : Invest in the beginning
- Create rapport quickly
- Elicit patient concerns
- Plan the visit with the patient
127
Characteristics of : Elicit the
| patient’s perspective
- Ask for patient ideas
- Elicit specific requests
- Explore the impact on the
patient’s life
128
Characteristics of: Demonstrate
| empathy
- Be open to patient’s emotions
- Make at least one empathic
statement
- Convey empathy nonverbally
- Be aware of your own
reactions
129
Characteristics of: Invest in the
| end
- Deliver diagnostic information
- Provide education
- Involve patient in making
decisions
- Complete the visit
